HomeMy WebLinkAbout13-085it* Alit
CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 5 2240-1 826
(3 19) 356-5040 CAl—
(319) 356-5497 FAX
First
1. Name
Authorization Number /3-3-5
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday - Friday.)
WED. AFe/L- 3
T a 5!; in Middle M
Last h LZ a i YL
2. Mailing Address 729r -1"d Ave Coy-atVItL0 IA -6 1 9- 4(
3. Telephone: Home 319 - 3 3 3- 6 j S 9 Other:
4. Prior experience in transportation of passengers:
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? l2 (7
Type of offense Where When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years?
Type of Offense Where When N (7
7. Have you been convicted of any traffic offenses in the last five years? /y 6
Type of offense Where When
8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /v V
Type of offense Where When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) �C7
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
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03/2013
I hereby certify that ve issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
��� 6 /} ,� �2 . I understand that if I falsely answer any questions in this application, that this
application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in
their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a license
is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant Date — O
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STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed . and sworn to, before me by �/Q ss i _Z -a On this b' " day of
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
U
Signatu a of Police Chief or designee
XV Z-/3
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Signat a of City Clerk or designee
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/a" (width) and 5'/2"
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
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Received Ti,me�Mar;,27.-2013— 4:14PM—•ND. 8609
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Iowa Department of Transportation
AO Office of Driver Services (Toil Free) 806-532-1121
PO Bac 9204, Des Moines, IA 503DO-9204 515-244-9124
FAX: 515-239-1837
Certified Abstract of Driving Record
Inquiry Date: 2/1/2013 DL/ID #: 666AJ2222 (IA)
Name: Alzain, Yassin Mohamed Class: D
Ahmed
Address: 729 E 2ND AVE Audit #: 6662222
Issue Date: 02/01/2013
City/State: CORALVILLE, IA Expiration 09/15/2018
522412201 Date:
Endorsements: 3
Mailing Address: 729 E 2ND AVE
Mailing City/State: CORALVILLE, IA
522412201
Restrictions: NONE
Date of Birth: 9/15/1976
Sex: M
History Information
CLEAR DRIVING RECORD
Name: Alzain, Yassin Mohamed Ahmed DL/ID: 666AI2222
Customer #: 6060081
ID Status: None
DL Status: VAL
CDL Status: None
CDL Cert None
Status:
CDL Med None
Status:
Restriction None
Supplement:
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby
certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an
official record currently in the custody of said office, and that I have been authorized by the Director of the Iowa Department of
Transportation to so certify.
In witness whereof, I have caused my signature and the seal or the Department to be set upon this document, at Ankeny, Iowa
this date:
..........:;�'/84�
2/1/2013
IOWA?'%c
..........
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Office of Driver Services
-1
Iowa Department of Transportation
Name: Alzain, Yassin Mohamed Ahmed DL/ID: 666A]2222